DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JANSEN, KIM D

002016400

(573) 897-2813

71 COTE DESSEIN LN
BONNOTS MILL
MO  65016-2338

JANSEN, KIM D



 

JANSEN, KIM D

kimjansen128@gmail.com


LAUREN R RAYWARNKE

BIRTH - 12 YEARS

10

FAMILY HOME

UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 8 CHILDREN IN CARE, ALL CHILDREN MAY BE UNDER AGE 2 WITH 2 ADULT CAREGIVERS
 
Inspection Information

01/11/2023

9:30 AM

10:34 AM

UNANNOUNCED

COMPLIANCE MONITORING

2438858394


DocumentDocument-Date
SAMPLE WEEKLY MENU 01/02/2007
ASSISTANT REFERENCES 05/12/2010
POLICIES 01/02/2007
DAILY SCHEDULE 01/02/2007
CHILD CARE/DISCIPLINE POLICIES 01/02/2007
DIAGRAM/OUTDOOR 01/02/2007
DIAGRAM/INDOOR 01/02/2007
APPLICATION 08/16/2018
ASSISTANT APPROVAL REQUEST 11/20/2019
SAFETY PLAN 12/01/2020
SANITATION INSPECTION 10/11/2022
FIRE/SAFETY INSPECTION 12/20/2022
EQUIPMENT LIST 01/11/2023
ANNUAL DECLARATION 01/11/2023
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 01/11/2023

Overlap Start TimeOverlap End TimeOverlap Submit Date
  3:45PM   5:30PM   9/14/2010
  7:00AM   7:15AM   9/14/2010



Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 2
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.
Attendance at Time of Inspection
Total Staff 1
Total Children 8
StaffChildClass AgeNote
1 8 MIXED K.J. with 8 children, two children age 1, three children age 2 and four children age 4.

Compliance List
5 CSR 25-400.025 Organization and Administration
Compliance
5 CSR 25-400.045 Licensing Process
Compliance
5 CSR 25-400.055 Annual Requirements
Violation
 Provider Comments
Violation
The Family Care Safety Registry check was not conducted for D.H. C.J., K.J., T.J., V.N., and N.S. within thirty (30) days prior to the anniversary date.
Licensing Rule Reference
5 CSR 25-400.055 Annual Requirements (2) (C) states: The child care provider shall conduct a Family Care Safety Registry check for all child care staff members within thirty (30) days prior to the anniversary date as printed on the license.
Correction Required
Required Family Care Safety Registry checks shall be conducted for all child care staff member(s) within thirty (30) days prior to the anniversary date.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.085 Physical Requirements of the Family Day Care Home
Compliance
5 CSR 25-400.086 Fire Safety
Violation
 Provider Comments
Violation
A portable electrical space heater was observed in use in the main child care space, plugged in on the left as you enter the entrance to the child care space.
Licensing Rule Reference
5 CSR 25-400.086 Fire Safety 12 (A) states: Unvented fuel-fired room heaters and portable electrical space heaters shall not be used during child care hours. The provider shall sign a compliance letter verifying that such equipment will not be used.
Correction Required
Space heaters/floor furnaces shall not be used.

Correction Verification
Corrected on Site

Compliance Date
1/11/2023
5 CSR 25-400.090 Disaster and Emergency Preparedness
Compliance
5 CSR 25-400.095 Furniture, Equipment and Materials
Compliance
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel
Violation
 Provider Comments
Violation
A caregiver did not submit the Clock Hour Training Reassignment form to apply current year's clock hours for the prior year. The following staff need clock hours reassigned to the previous year: K.J. needs 5 hours to be transferred back to 2022.
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (4) (I) states: Clock hours earned to complete the previous year’s requirements shall not be applied to the current year’s clock hour requirements. Caregivers shall submit the Clock Hour Training Reassignment form, revised 2020 and incorporated by reference in this rule, as published by the Missouri Department of Elementary and Secondary Education, PO Box 480, Jefferson City, MO 65102-0480 and available by the department at https://dese.mo.gov/childhood/forms, to the OPEN Initiative to assign clock hours to the appropriate year.
Correction Required
Caregivers shall submit the Clock Hour Training Credit Reassignment form to reassign current year's clock hours to the prior year.

Correction Verification
Corrected on Site

Compliance Date
1/11/2023
Violation
Safe sleep training was not completed within the past 3 years for the assistant(s), C.J. and N.S..
Licensing Rule Reference
5 CSR 25-400.105 The Child Care Provider and Other Child Care Personnel (5) . states: Safe Sleep Training. Every three (3) years the provider and assistant(s) in a family child care home licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, by Moon RY, which is incorporated by reference in this rule as published in PEDIATRICS Volume 138, No. 5, November 1, 2016 and available at http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/20/peds.2016-2938.full.pdf. This rule does not incorporate any subsequent amendments or additions.
Correction Required
The child care provider and assistant(s) shall complete department approved safe sleep training as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-400.115 Child Care Family and Household
Compliance
5 CSR 25-400.125 Medical Examination Reports
Compliance
5 CSR 25-400.135 Admission Policies and Procedures
Compliance
5 CSR 25-400.145 Nighttime Care
Compliance
5 CSR 25-400.155 Overlap Care of Children
Compliance
5 CSR 25-400.165 Emergency School Closings
Compliance
5 CSR 25-400.175 Child Care Program
Compliance
5 CSR 25-400.185 Health Care
Compliance
5 CSR 25-400.190 Nutrition and Food Service
Compliance
5 CSR 25-400.200 Transportation and Field Trips
Compliance
5 CSR 25-400.210 Records and Reports
Compliance
5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 Background Screening Findings
Compliance
RSMo 210.115. Reports of abuse, neglect, and under age eighteen deaths - persons required to report - supervisors and administrators not to impede reporting - deaths required to be reported to the division or child fatality review panel, when - report made to another state, when.
Compliance
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Compliance
RSMo 210.252. Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance